江小宇

【摘要】 目的：研究胃黏膜下腫瘤全層切除術(shù)（EFTR）術(shù)后創(chuàng)面缺損采用內(nèi)鏡下單鉗道鈦夾聯(lián)合尼龍圈“荷包”縫合的臨床效果。方法：回顧性分析2016年2月-2017年7月在筆者所在醫(yī)院接受胃黏膜下腫瘤全層切除術(shù)治療的82例患者臨床資料，按照手術(shù)后止血方法分為觀察組和對(duì)照組，每組41例。對(duì)照組術(shù)后對(duì)創(chuàng)面予以常規(guī)止血處理，確定無(wú)活動(dòng)性出血后結(jié)束手術(shù)。觀察組術(shù)后則對(duì)創(chuàng)面予以單鉗道內(nèi)鏡下鈦夾聯(lián)合尼龍圈“荷包”縫合。比較兩組手術(shù)時(shí)間、縫合時(shí)間、術(shù)后住院時(shí)間、術(shù)后并發(fā)癥發(fā)生情況，以及術(shù)后12個(gè)月復(fù)發(fā)率、遠(yuǎn)處轉(zhuǎn)移率。結(jié)果：觀察組與對(duì)照組的手術(shù)時(shí)間、縫合時(shí)間對(duì)比差異均無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）;但觀察組術(shù)后住院（5.62±1.19）d，短于對(duì)照組的（6.63±2.15）d。觀察組遲發(fā)性出血、遲發(fā)性穿孔、術(shù)后感染及術(shù)后腹痛發(fā)生率分別與對(duì)照組相比，差異均無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。觀察組術(shù)后12個(gè)月復(fù)發(fā)率及遠(yuǎn)處轉(zhuǎn)移率與對(duì)照組相比差異均無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。結(jié)論：胃黏膜下腫瘤全層切除術(shù)后創(chuàng)面缺損采用單鉗道內(nèi)鏡下鈦夾聯(lián)合尼龍圈“荷包”縫合效果較好，不會(huì)增加并發(fā)癥發(fā)生率，且不會(huì)增加術(shù)后復(fù)發(fā)率及遠(yuǎn)處轉(zhuǎn)移率。

【關(guān)鍵詞】 胃部腫瘤; 黏膜下腫瘤; 單鉗道內(nèi)鏡縫合

doi：10.14033/j.cnki.cfmr.2019.17.007 文獻(xiàn)標(biāo)識(shí)碼 B 文章編號(hào) 1674-6805（2019）17-00-03

【Abstract】 Objective：To research the clinical effect of endoscopic single-channel titanium clip combined with nylon ring “Pouch” suture for wound defect after endo-scopic full-thickness resection（EFTR） of gastric submucosal tumors.Method：The clinical data of 82 patients receiving endo-scopic full-thickness resection of gastric submucosal tumors in our hospital from February 2016 to July 2017 were analyzed retrospectively.They were divided into the observation group and the control group by methods of hemostasis after operation，41 cases in each group.Patients in the control group were given routine treatment of wound hemostasis，no active bleeding after the end of surgery.In the observation group，single-channel titanium clip combined with nylon ring “Pouch” suture for wound defect after endo-scopic full-thickness resection was given to the wound after.The two groups were compared with operative time，suture time，postoperative hospital stay，recurrence rate of 12 months and the incidence of postoperative complications，distant metastasis rate.Result：The operation time and suture time of the observation group and the control group were not significantly different（P>0.05），but the postoperative hospitalization time of the observation group was （5.62±1.19）d，significantly lower than （6.63±2.15）d of the control group.The incidence of delayed bleeding，delayed perforation，postoperative infection and postoperative abdominal pain in the observation group compared with the control group，the differences were not statistically significant（P>0.05）.The recurrence rate and distant metastasis rate of the observation group at 12 months after operation compared with the control group，the differences were not statistically significant（P>0.05）.Conclusion：Titanium clip combined with nylon ring “Pouch” suture under single forceps endoscopy after total gastric submucosal tumor resection is effective，it will not increase the incidence of complications and the recurrence rate and distant metastasis rate after operation.